These Argentinean researchers compared clinical records for 109 patients with DLB and 251 patients with "Alzheimer disease type," and evaluated whether or not these patients had attention-deficit and hyperactivity disorder (ADHD) prior to the onset of DLB or ADT. They found that there was a "higher risk of DLB in patients with preceding adult ADHD symptoms." There is "no clear explanation for the association found."
Robin

Abstract
Introduction: Previous reports have shown that in Dementia with Lewy body (DLB) and attention-deficit and hyperactivity disorder (ADHD) a hypodopaminergic and noradrenergic substrate seems to play a central role in developing the diseases. We investigated the hypothesis that attention deficit may precede DLB expressed as adult ADHD symptoms long before the clinical onset of dementia.

Methods: Patients with DLB, Alzheimer disease type (ADT) and controls were recruited from the membership of the Italian Hospital Medical Care Program in Argentina from 2000 to 2005. The DSM-IV criteria adapted for the identification of adult patients with ADHD and validated to Spanish Wender Utah Rating Scale were used to identify individuals with preceding ADHD symptoms during their adult life. Analysis of categorical variables was carried out using chi-square. Mann-Whitney test was used for continuous variables. Statistical significance was P < 0.05.

Results: A total of 109 patients with DLB and 251 patients with ADT were matched by age, sex and year of education with 149 controls. The frequency of preceding ADHD symptoms in DLB cases was 47.8% in ADT 15.2% and 15.1% in the control group. The prevalence of ADHD symptoms in DLB cases was significantly higher compared with the control group (P </= 0.001, OR 5.1 95%CI 2.7-9.6) and also higher when compared with ADT (P </= 0.001, OR 4.9, 95%CI 2.8-8.4).

Conclusion: We found a higher risk of DLB in patients with preceding adult ADHD symptoms. To date, there is no clear explanation for the association found; however, further investigation will widen our understanding about both disorders.

This ADHD- and LBD-related research published over eight months ago has sparked a recent WebMD article, copied below. This is the key paragraph:

But a U.S.-based expert cautions that the study found an association between ADHD symptoms and the dementia, not cause and effect. "It may be that both of these disorders are linked to some other risk factor that is common for both," says James B. Leverenz, MD, chair of the Lewy Body Dementia Association's scientific advisory council and professor of neurology and psychiatry and behavioral sciences at the University of Washington, Seattle. He reviewed the study for WebMD.

Both Drs. Leverenz and Galasko, quoted below, are on the LBDA's Scientific Advisory Council.

Jan. 20, 2011 -- Adults with symptoms of ADHD, or attention deficit hyperactivity disorder, are more than three times as likely as other adults to develop a form of dementia later in life, according to new research from Argentina.

''We found a higher risk of dementia with Lewy bodies in patients with preceding adult ADHD symptoms," write the researchers from Hospital Italiano Buenos Aires. The study is published in the European Journal of Neurology.

Lewy body dementia (LBD) affects about 1.3 million people in the U.S., according to the Lewy Body Dementia Association. Lewy bodies is the name given to the abnormal protein deposits that disrupt the brain's normal functioning.

The symptoms include cognitive impairment, like the more well-known dementia, Alzheimer's disease. However, in the Lewy body form, patients can also have visual hallucinations, fluctuation in cognition -- sometimes appearing fine, other times not -- and motor abnormalities similar to those in Parkinson's disease patients.

But a U.S.-based expert cautions that the study found an association between ADHD symptoms and the dementia, not cause and effect. "It may be that both of these disorders are linked to some other risk factor that is common for both," says James B. Leverenz, MD, chair of the Lewy Body Dementia Association's scientific advisory council and professor of neurology and psychiatry and behavioral sciences at the University of Washington, Seattle. He reviewed the study for WebMD.

ADHD and Dementia: The Study

Led by Angel Golimstok at the Hospital Italiano Buenos Aires, researchers evaluated 360 patients with dementia -- 109 had LBD and 251 had Alzheimer's -- comparing them with 149 healthy people matched by sex, education, and age.

Then they looked at how often ADHD symptoms had been reported earlier. In patients who were too impaired to answer, they got information from an informant who had known the patient for at least 10 years and had information from a close relative who knew the patient in childhood. The researchers say that since this method has not been validated, they refer to the patients as having ADHD symptoms, rather than being diagnosed with ADHD.

They found:

* 47.8% of those with LBD had previous ADHD symptoms.* 15.2% of those with Alzheimer's disease had previous ADHD symptoms.* 15.1% of those in the healthy group did.

Why the link? "It is believed that the same neurotransmitter pathway problems are involved in the development of both conditions, so our research set out to test the theory that adult ADHD often precedes [Lewy body dementia],'' Golimstok says in a news release.

The researchers believe their study is the first to look at the link between ADHD symptoms and dementia.

In ADHD, often diagnosed in childhood, people have problems paying attention and can act impulsively. Symptoms can persist into adulthood.

âOur hypothesis is that ADHD could be the clinical result of the first step in these pathway disorders, and after a long time, this problem degenerates to a more severe pathology with structural changes in the brain, as Lewy Body Dementia is," Golimstok writes in an email interview with WebMD.

"A question to answer in the very near future is, Could available ADHD treatment prevent the conversion to a degenerative disease such as Lewy Body Dementia?" Golimstok writes.

ADHD and Dementia: Exploring the Link

Although the study doesn't prove cause and effect between ADHD and dementia, it is valuable, Leverenz says.

"The importance in this study ... is that we are trying to identify early symptoms and characteristics that may predict who is at high risk of developing this disease," he says of LBD.

That way, when a preventive treatment does become available, he says, ''We can help these people."

An ADHD expert who also reviewed the study for WebMD says the conclusion is backward. Instead of saying that people with ADHD symptoms are three times as likely to get LBD, the researchers should have concluded that "patients with LBD had three times the rate of ADHD symptoms," says L. Eugene Arnold, MD, professor emeritus of psychiatry at Ohio State University's Nisonger Center and a longtime ADHD researcher.

But Arnold says the link found is worth exploring and that the neurotransmitter problems thought to be involved in ADHD in fact may also be involved in the dementia.

Like other experts, Arnold says that retrospective studies are inherently flawed, as people must recall their histories or those of loved ones.

"The authors tried to obtain ratings of ADHD during childhood from knowledgeable informants of the patients and controls, and much hinges on the accuracy of these reports, and on their interpretation," says Douglas Galasko, MD, professor of neurosciences at the University of California San Diego, who also reviewed the study. He says the next step is replication of the findings by other researchers.

ADHD and Dementia: What to Do Now?

Meanwhile, is there anything an adult with ADHD might do to minimize later risk of dementia?

"I always tell people we don't know how to prevent this disease," Leverenz says of LBD. "However, we do know that people who maintain their general health -- the old boring stuff, exercise, proper diet -- they seem to be able to resist the effect of the disease better."

Arnold agrees. "Those two things will do a lot to prevent or delay most diseases."

Wed Jan 26, 2011 6:36 pm

JeanneG

Joined: Fri Dec 31, 2010 3:07 pmPosts: 1039Location: Minnesota

Re: ADHD sufferers are at a higher risk of DLB than AD

Wait, wait, wait ... I'm missing something here entirely. This doesn't say the finding were based on post mortem confirmed cases, does it? And don't we know that something like 65 to 70% of all LBD diagnoses turn out not to be LBD when the brains are examined? So how can we compare two populations with "probable" but unconfirmed dementia diagnosis? I just don't get it.

Is this study relying on caregiver's personal memories of ADHD plus doctor's unconfirmed diagnosis of LBD? If that's it, I am not impressed at all.

Or do they have a better accuracy rate with their LBD diagnosis in Argentina than we do?

_________________Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012

I think you are exactly right: no need to be impressed. I didn't even bother to get the full journal article at the time as I thought it was no big deal.

I'm unclear as to the "flurry" of activity around this study. I think the flurry may be limited to the WebMD article, and then the LBDA's promotion of the WebMD article.

Wed Jan 26, 2011 7:13 pm

JeanneG

Joined: Fri Dec 31, 2010 3:07 pmPosts: 1039Location: Minnesota

Re: ADHD sufferers are at a higher risk of DLB than AD

Well, it sure looks like a flurry if you Google ADHD and Lewy. It is being presented as a "fact" that, as one headline put it, "Adult ADHD significantly increases risk of common form of dementia." It doesn't take long for this kind of message repeated on website after website (and I assume in print media) to raise unfounded concerns and divert attention from more substantiated facts and theories.

If all it takes to "prove" connections is to take diagnosis at face value and ask for people to self-report prior conditions, well, that would certainly bring down the cost of research, wouldn't it? And eliminate the need for brain tissue.

I am glad that LBDA is addressing this, and countering the "flurry" with a more reasoned look at the study. I count on LBDA to sort through this kind of thing and keep us informed.

_________________Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012

Wed Jan 26, 2011 7:33 pm

mockturtle

Joined: Wed Dec 30, 2009 1:46 pmPosts: 3213Location: WA

Re: ADHD sufferers are at a higher risk of DLB than AD

Quote:

But a U.S.-based expert cautions that the study found an association between ADHD symptoms and the dementia, not cause and effect.

Always important to point out. Thank you, Robin.

_________________Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.

Yes, it's hard to remember that "associations" are not "causal relationships."

Wed Jan 26, 2011 9:14 pm

sharone

Joined: Mon Nov 22, 2010 1:24 pmPosts: 57

Re: ADHD sufferers are at a higher risk of DLB than AD

I find the correlation between ADHD and LBD interesting and not at all surprised this hypotesis has been made. I may even be impressed.

Researchers from the beginning of time have tried to understand the brain. LBD is just one disorder trying to be understood to better, quality of life of the inflicted and their families. Psychologists and nerologists look for patterns and use the DSM criteria to help guide their judgements about medications and treatments. How does a nero diagnose lbd? They pull together the info from loved ones and medical/psyc HISTORIES Do they rely on questioneers and rating scales? Yes, just like they do to diagnose ADHD and dyslexia/reading disabilites. REAL conditions. Not made up or faked to get accommodations for learning. Are there tests for these conditions. Researchers are currently doing FMRI to identify dylexia (for research purposes)just as they are doing with dementia research. Why dont they complete these tests on everyone they suspect. $$$$$$$$

All of these conditions that effect the brain are soooooo frustrating. Family and friends may or may not believe a condition exists. Sound familiar?????

I appreciated learning that Dr Boeves research is based on his experiences and observations with LB and that Mayo has received some money.

I am a former special education teacher with lots of experience with Dyslexia and ADHD. It is CLEAR to me that most people do not have a clear understanding of either. Dyslexia for example is a phonological processing disorder, not a visual disorder. Dyslexia and dementia share "word finding" problems. ADHD is a frontal lobe disorder with the patient having difficulty with planning, organizing, attention, memory.... I find peoples misunderstanding of these disorders as frustrating as those that misunderstood my mothers dementia!

Maybe someday, these disorders can be well understood and differentiated from one another Sharon E.

P.S. I want to thank the brave souls with the disorder who so humbly tell thier stories!!!

Last edited by sharone on Mon Apr 18, 2011 12:03 pm, edited 1 time in total.

There is research going on as to learning disabilities and FTD (frontotemporal dementia) connections. As you point out, some learning disabilities and ADHD are thought to have frontal lobe connections.

I don't know of any research going on with learning disabilities and DLB.

Robin

Sun Apr 17, 2011 3:35 pm

Galadriel724

Joined: Wed Nov 16, 2011 10:27 amPosts: 3

Re: ADHD sufferers are at a higher risk of DLB than AD

Just wanted to pop in with some personal perspective on this issue. I have ADHD. Severely. I am intelligent and focus every bit of effort into focusing and organizing myself. Mainly at work- I'm an RN, and a good one, but for a person with ADHD, doing the same things as ppl without ADHD is possible but requires much more effort. I spill over; with my symptoms, outside work. Some friends say I am next to CHAOS in the dictionary. I don't dispute it.Anyway, my dad, who has a diagnosis of LBD, had the same issues as me. We actually discussed this when he was still more or less able to reason and had perspective. He met the criteria for ADHD. Like ALL of them, you only need to meet like 2 thirds to make the cut. It started as early as we both did in life. Some people say it's a gift, I say that if it wasn't there I could do so many more wonderful things than I do now.I have had various sleep related issues for most of my life, some associated with the ADHD, like delayed sleep phase disorder. However I have had night terrors at one point, and now I sleepwalk. Ugh. Along with that and the fact that my dad and I are both hypersensitive to neuroleptics (found out with compazine), and both had mental status changes after flying in a plane (he had the dementia, I had just had surgery and was still loopy from the meds- lost a month of memory), I really don't waste time wondering if I'll end up with LBD. Probably. I'd be surprised if I didn't. More so because of our specific similarities but it hit me really hard in the gut when they were found to appear more often together than with other dementias, because ADHD is one of the most genetically linked disorders that exist, more than bipolar. So, for the group that do have the ADHD, just the association means a lot for our genetic risks.

Wed Nov 16, 2011 12:00 pm

JeanneG

Joined: Fri Dec 31, 2010 3:07 pmPosts: 1039Location: Minnesota

Re: ADHD sufferers are at a higher risk of DLB than AD

Galadriel724, I can see why you would be concerned about developing LBD yourself. I hope that concern helps you to prepare to get the best care available, in case it does develop.

On the other hand, if you live to be 80, you (and I, if I make that milestone) have about a 50% chance of developing some kind of dementia. Sigh. We can all be very thankful that there is a lot of research going on. I'm very grateful for every brain donated to research, and to all the very dedicated researchers working to unravel the mysteries of deentia.

_________________Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012

Wed Nov 16, 2011 4:13 pm

aelisabeth

Joined: Tue Aug 30, 2011 1:42 pmPosts: 108

Re: ADHD sufferers are at a higher risk of DLB than AD

Wow! I have been wondering for years about this issue (well Parkinson's and ADHD - since DLB is relatively new to my lexicon). My mother had very serious ADHD when she was a child (also bi-polar and seasonal depression). I too had ADD and I probably still do (although I have developed pretty good strategies to work around ADD). My boys both seem to have ADD (not ADHD) and I worry about them. I asked my mother's neurologist years ago about whether or not there was a link and he said that the research had not really been done yet. Being an anthropologist myself, I often rely on more qualitative than quantitative data, but I sure would love to see more quantitative research done on this. Does anyone know if there is any research done that shows that ADHD/ADD drugs reduces or increases the risk of DLB later in life? I have been working to help my kids learn coping strategies rather than seeking out drugs, but if medication would reduce their risks of this horrible disease, I would certainly want to pursue it (but as many of these comments have suggested - it is likely to be a correlative relationships and not a casual one). Do any of you more medically minded folks know of other studies that one might want to look at concerning this issue?

Thanks -Liz

Wed Mar 21, 2012 3:08 am

BayouCajun

Joined: Tue Mar 29, 2011 3:02 pmPosts: 386Location: East TN

Re: ADHD sufferers are at a higher risk of DLB than AD

brings to mindâ¦..from Mayo Habit Programâ¦.MCI programâ¦..

a session from Dr. Amit Soodâ¦.

and the Meercat Sentryâ¦â¦

50 years of Meercat Sentry behaviour = no goodâ¦.

wouldn't it be great if DLB could be prevented with just enough relaxation?

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